超高龄高血压病患者动态血压和左室肥厚关系的研究

A study of relationship between ambulatory blood pressure and left ventricular hypertrophy in very elderly hypertensive patients

目的研究超高龄(≥80岁)高血压病患者动态血压监测与左室肥厚的关系及临床意义。方法按年龄将296例被观察者分为超高龄高血压组(116例)、老年高血压组(90例)、中青年高血压组(90例),采用动态血压监测及超声心动图观察平均动脉压、昼夜收缩压(24 h SBP)、舒张压(DBP)水平和左室重量指数(LVMI)等。结果24 h SBP、nSBP、nSBP/dSBP、SBPL和LVH正相关,单纯收缩期高血压ISH、血压昼夜节律消失BPRD的发生率和LVH的发生率正相关。随着年龄的增加,室内隔厚度(IVST)、左室舒张末期内径(LVDd)、左室后壁厚度(LVPW)和LVMI逐渐增加,有统计学意义(分别为P<0.05,P<0.01),(ISH)、(BPRD)和左心室肥厚(LVH)的发生率明显增高,有统计学意义(分别为P<0.05,P<0.01)。结论24 h sbp、nSBP、nSBP/dSBP、SBPL与老年高血压患者的左心室肥厚关系密切,单纯收缩期高血压(ISH)和非杓型高血压更易发生左心室肥厚。年龄增加是左心室肥厚的一个重要因素。

Objective： To explore the relation between the parameter of ambulatory blood pressure monitoring （ABPM） and left ventricular hypertrophy （LVH） and the clinical significance in very elderly hypertensive patients. Methods： 296 essential hypertensive patients were divided into three groups by age. They were very elderly group, elderly group, and young and middle-age group （116, 90 and 90, respectively）. The ambulatory blood pressure was measured for 24 hours and the left ventricular mass indexer （LVMI） were measured with echocardiography according to Devereur＇ s correction formula. Results： 24h sbp,nSBP, nSBP/dSBP and SBPL had positive correlation with LVH. IVST, LVDD, LVPW and LVMI were significantly higher in very eldly hypertensives than those of elderly hypertensives and young and middle-age hypertensives （ P 〈 0. 05, P 〈 0. 01, respectively）. The incidence rate of isolated systolic hypertension （ ISH）, blood pressure rhythm disappeared （BPRD） and LVH were also significantly higher in very elderly than those of elderly hypertensives and young and middle-age hypertensives （ P 〈 0. 05, P 〈 0. 01, respectively）. Conclusion ： 24h sbp, nSBP, nSBP/dSBP and SBPL are the important factors affecting LVH in very elderly hypertensive patients. ISH and Non-dipper induce LVH more easily. Aging is an important factor of LVH.